Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) using 19G needle tract: First case series from India

EBUS-TBNA is a well-established procedure for diagnosis of mediastinal lymphadenopathy replacing the need for mediastinoscopy. In certain diseases like lymphomas, the yield is reportedly 50%, sarcoidosis lymph nodes also give a yield of 80% with EBUS and at times, more material is needed for better characterization of malignancies. EBUS-intranodal forceps biopsy may be useful in these situations. In our series of seven cases, we describe a unique and safe technique of obtaining forceps biopsy from mediastinal lymph nodes under real-time endobronchial ultrasound guidance using a 19G EBUS-TBNA needle tract and thin biopsy forceps. Lymph node biopsy was able to give a conclusive diagnosis in 42% patients negative with TBNA, and was able to suggest a diagnosis in one case. No complications were seen. Thus, surgical biopsy can be avoided in nearly 50% of failed EBUS-FNAC cases.